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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Preeclampsia

Preeclampsia_SmallPreeclampsia, also known as toxaemia or pregnancy induced hypertension (PIH), is a hypertensive condition that only occurs during pregnancy and the postpartum period.

Preeclampsia is characterized by an elevation in the expectant mother's blood pressure combined with; oedema (swelling in the ankles, feet, legs and hands); and the appearance of excessive protein in her urine. Preeclampsia is generally diagnosed after the 20th week of pregnancy and may be of sudden or slow onset.

With the correct diagnosis and management, most women with preeclampsia fully recover and go on to deliver healthy babies. However, in its most severe form (known as eclampsia), resulting from delays in treatment and complications, the condition can have a devastating and potentially life-threatening effect on both mother and baby before, during or after birth. Preeclampsia in its mildest form tends to occur in 5-10% of pregnancies. It is most common in first time mothers, mothers who experienced it in their previous pregnancy, and some women develop the condition after experiencing high blood pressure prior to pregnancy.

Symptoms:
  • Severe abdominal pain (often experienced at night, below the ribs on the right hand side)
  • Bleeding that is bright red and/or profuse
  • Shortness of breath
  • Burning behind the sternum
  • Nausea and vomiting
  • Headaches
  • Vision disturbances, such as blurred vision, seeing flashing spots or auras
  • Confusion
  • Heightened state of anxiety
  • A sudden drop in the number of times you experience your baby's movements, over a period of several hours, is noticed
  • The sensation that your waters may have ruptured or may be leaking

Preeclampsia and eclampsia can both develop in the first 4 weeks following delivery. If any of the above symptoms begin after the birth of your child, report them to your provider immediately.

Diagnosis:

Some women with preeclampsia develop certain symptoms that cause them to seek medical advice (see above). However, if the condition is mild, overt symptoms may not be present. It is therefore essential to have your blood pressure and urine checked regularly during pregnancy.

High blood pressure or hypotension means that the force of blood pushing against your artery walls is too high.

Normal blood pressure below 140/90 mm Hg.
Mildly high blood pressure 140/90 and 149/99 mm Hg.
Moderately high blood pressure 150/100 and 159/109mm Hg.
Severely high blood pressure 160/110 mm Hg or higher.

A simple test can be used to detect whether protein is leaking from your kidneys into your urine. If there is protein in your urine on testing with a dipstick, your doctor may collect your urine over a 24-hour period so that the total amount of protein in your urine can be tested.

Tests may be done to check on your baby's wellbeing. This may include recording your baby's heart rate, performing an ultra sound scan to monitor your baby's growth, and a scan to see how effectively blood is circulating between the placenta and your child.

Causes:

It is not fully understood why some women's bodily systems become increasingly unable to cope with the pregnancy, and they develop preeclampsia. Poor nutrition, insufficient blood supplies to the uterus, and high body fat have been put forward as potential causes.

Risk factors:

Possible risk factors include; multiple pregnancies, obesity (BMI > 35), diabetes, kidney disease, lupus, or rheumatoid arthritis, pregnancy in early teens, first pregnancies, women over the age of 40, and a family history of preeclampsia.

Treatment:

Treatment is individualized in accordance with the gestational age and health of the baby, the overall health and age of the mother, and the progression of the disease in general. This involves monitoring the mother's blood pressure, and assessing the functioning of her kidneys, liver and the ability of her blood to clot. Other tests are used to monitor the unborn baby, to ensure that by growth is taking place and baby is not in distress. If the pregnancy is 37 weeks or more, your provider may opt to deliver. If the pregnancy is less than 37 weeks, they may try prolonging the pregnancy.

If there are signs of instability in the mother, such as very high blood pressure that is not responding to antihypertensive drugs, signs of kidney and/or liver failure, a reduction in the number of red blood cells or platelets, or signs of an impending seizure or stroke, attempts will be made to stabilize the disease. Antihypertensive drugs are used to reduce dangerously high blood pressure. Magnesium sulfate is an anticonvulsant specifically used for preeclampsia, if it appears that the brain is about to stroke or a seizure is immanent.

If the baby is growing insufficiently or not at all and scores poorly on the "stress test", premature delivery may be essential to protect the mother and ensure the baby's survival. This occurs if the disease cannot be stabilized and the baby would not survive if left in the uterus. The only cure for severe preeclampsia is the delivery of the baby, irrespective of the baby's age.

If you are diagnosed with slow-onset preeclampsia and your symptoms are mild, you may be able to stay at home. Your urine and blood pressure will be monitored frequently, and you will need to get lots of rest. Your provider may prescribe medication to prolong the pregnancy and monitor your fluid intake. You will also do daily foetal kick counts.

If there is a chance that labour needs to be induced or there is a need to deliver your baby by Caesarian section and your baby is still premature, your doctor may advise the use of steroid drugs to help mature your baby's lungs.

Prevention:

There are no specific recommendations on how to prevent preeclampsia. It is essential to have good prenatal care, keep all prenatal visits and be aware of the warning signs of preeclampsia, so as to detect and treat the condition early.

References:

Baby Center, L.L.C. Preeclampsia. Baby Center. http://www.babycenter.com/0_preeclampsia_257.bc?page=1. Updated March 2011. Accessed July 26, 2012.

Cooper C, ed. Johnson's mother and baby: Pregnancy, birth and the first three years of your baby's life. London: Dorling Kindersley; 2003.

Patient.co.uk. Pre-eclampsia. Patient.co.uk. http://www.patient.co.uk/pils.asp. Accessed July 19, 2012.

Preeclampsia Foundation. About Preeclampsia. Preeclampsia Foundation. http://www.preeclampsia.org/. Published February 7, 2011. Accessed July 19, 2012.

WebMD, L.L.C. Preeclampsia and Eclampsia. WebMD. http://www.webmd.com/a-to-z-guides/common-topics/default.htm. Reviewed March 7, 2010. Accessed July 20, 2012.